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Everything you need to know about Computed Tomography (CT) & CT Scanning


Cinematic Rendering: Principles, Applications, and Observations in CT

Cinematic Rendering: Principles, Applications, and Observations in CT

Steven P. Rowe, M.D., Ph.D.
Elliot K. Fishman, M.D.
The Russell H. Morgan Department of Radiology and Radiological Science
Johns Hopkins University School of Medicine
Baltimore, MD, USA

 

Cinematic Rendering (CR)

  • A new 3D visualization method for volumetric CT (and MRI) data
  • Allows for photorealistic/life-like rendering with enhanced surface detail and realistic shadowing effects
Eid M, De Cecco CN, Nance JW Jr, et al. AJR Am J Roentgenol. 2017;209:370-379.
Johnson PT, Schneider R, Lugo-Fagundo C, et al. AJR Am J Roentgenol. 2017;209:309-312.

 

Cinematic Vs. Volume Rendering

  • Both CR and volume rendering (VR) make use of thin-slice reconstructed isotropic voxels
  • The thin-slice reconstructions are stacked to create a volume for both methods
  • Each voxel is assigned a color and translucency based on its density/component tissues

 

Cinematic Vs. Volume Rendering

  • However, the differences in the techniques arise from the type of lighting model used
  • VR makes use of ray casting
    • Single ray of light passing through the volume produces a pixel that is the sum total of the colors and translucencies of the voxels through which it has passed.
Johnson PT, Schneider R, Lugo-Fagundo C, et al. AJR Am J Roentgenol. 2017;209:309-312.

 

Cinematic Rendering: Strikingly Different from other 3D Methods

CR uses a global lighting model that creates effects including realistic shadowing, appropriate obscuration of the light source depending on the relationship with the light source and the image in the volume, etc.

Johnson PT, Schneider R, Lugo-Fagundo C, et al. AJR Am J Roentgenol. 2017;209:309-312.

 

Clinical Utility of Cinematic Rendering has not Been Established

  • However, it is being actively studied.
  • Role in pre-operative prognosis and planning?
  • Trainee education in complex anatomy?
  • Patient engagement given the easily understood nature of the photorealistic depictions?

 

Clinical Examples of Cinematic Rendering

  • Exhibit focuses on normal anatomy, oncology, musculoskeletal, and vascular cases.
  • Images are designated with CR (cinematic rendering), VR (volume rendering), MIP (maximum intensity projection), or 2D, as appropriate.

 

Calvarial, Skull Base, and Maxillofacial Normal Anatomy

Calvarial, Skull Base, and Maxillofacial Normal Anatomy

VR vs. CR: normal skull anatomy

 

Calvarial, Skull Base, and Maxillofacial Normal Anatomy

Calvarial, Skull Base, and Maxillofacial Normal Anatomy

 

Calvarial, Skull Base, and Maxillofacial Normal Anatomy

Calvarial, Skull Base, and Maxillofacial Normal Anatomy

Photorealistic images such as these cinematic renders may prove invaluable in trainee education

 

Calvarial, Skull Base, and Maxillofacial Normal Anatomy

Calvarial, Skull Base, and Maxillofacial Normal Anatomy

 

Forearm and Hand Anatomy with Varying Window Widths and Levels

As with any 3D technique, an important aspect to the creation of diagnostically useful images is the real-time interaction of the radiologist with the software to ensure that all relevant pathology is appropriately displayed.

 

Cinematic Rendering of Forearm and Hand

Cinematic Rendering of Forearm and Hand

The potential for CR to replace MRI for soft tissue and tendon evaluation in certain situations should be extensively investigated

 

Cinematic Rendering of Forearm and Hand

Cinematic Rendering of Forearm and Hand

Changes in widow width, window setting, and transparency can allow for almost any tissue or combination of tissues to be displayed in the visualizations

 

Cinematic Rendering of Forearm and Hand

Cinematic Rendering of Forearm and Hand

Viewing the volume from different virtual points of view will ensure that key findings are not missed because of the realistic shadowing effects/obscuration of the light source that are intrinsic to the method

 

Normal Fetal and Placental Anatomy can be Well-Evaluated

Note the shadowing that occurs between the pubic symphysis and the fetal skull in the last two images (red arrowheads) that allows for a definitive understanding of the relative locations of those objects

Normal Fetal and Placental Anatomy can be Well-Evaluated

Rowe SP, Fishman EK. Radiol Case Rep. 2017; Ahead of print.

 

Highly Detailed Head and Neck Soft Tissue Anatomy can be Rendered

Highly Detailed Head and Neck Soft Tissue Anatomy can be Rendered

 

Highly Detailed Head and Neck Soft Tissue Anatomy can be Rendered

Highly Detailed Head and Neck Soft Tissue Anatomy can be Rendered

 

Highly Detailed Head and Neck Soft Tissue Anatomy can be Rendered

Highly Detailed Head and Neck Soft Tissue Anatomy can be Rendered

 

Highly Detailed Head and Neck Soft Tissue Anatomy can be Rendered

Highly Detailed Head and Neck Soft Tissue Anatomy can be Rendered

Small structures, such as the submandibular glands (red arrows) are delineated on CR images, and aspects of the textures of the glands can be appreciated.

 

Normal Stomach Anatomy

Normal Stomach Anatomy

The level of surface detail that can be achieved with CR allows the texture of the folds of the stomach to be depicted in the second of these panels

 

Destructive Facial Squamous Cell Carcinoma

Destructive Facial Squamous Cell Carcinoma

CR of facial squamous cell carcinoma – appropriate window settings allow one to “move through” the layers of soft tissue to display more of the underlying bone structure

 

Squamous Cell Carcinoma Invading the Calvarium

Squamous Cell Carcinoma Invading the Calvarium

Note the excellent display of the vascular map of the lesion on the CR images as well as the photorealistic appearance of the body calvarium

 

Calvarial, Skull Base, and Maxillofacial Anatomy and Pathology

Calvarial, Skull Base, and Maxillofacial Anatomy and Pathology

Posterior calvarial osteoma: note the shadowing around the interface between the osteoma and the overlying skull, indicating that this lesion arises from a bony stalk

 

Cinematic Rendering of Pancreas Serous Cystadenoma

Cinematic Rendering of Pancreas Serous Cystadenoma

 

Pancreatic Lipoma

Pancreatic Lipoma

 

Adencarcinoma of the Tail of the Pancreas

Adencarcinoma of the Tail of the Pancreas

Note the excellent delineation of the duodenal invasaion (red arrows) on the CR images

 

Pancreatic Adenocarcinoma with Vascular Invasion

Pancreatic Adenocarcinoma with Vascular Invasion

Note the ability of CR to display the abdominal vasculature including the collateral vessels in a photorealistic manner.

 

Pancreatic Adenocarcinoma with Upstream Atrophy

Pancreatic Adenocarcinoma with Upstream Atrophy

Note the texture change that is visible between normal pancreas, the tumor (red arrows) and the atrophied pancreatic tail on the CR images.

 

Pancreatic Neuroendocrine Tumor with Extensive Neovascularity

Pancreatic Neuroendocrine Tumor with Extensive Neovascularity

 

Pancreatic Neuroendocrine Tumor with Extensive Neovascularity

Pancreatic Neuroendocrine Tumor with Extensive Neovascularity

Note the effective depiction of the “nest” of tumor neovascularity that surrounds the tumor in the bottom panels.

 

Large, Highly-Vascular Gastro-Intestinal Stromal Tumor

Large, Highly-Vascular Gastro-Intestinal Stromal Tumor

 

Large, Highly-Vascular Gastro-Intestinal Stromal Tumor

Large, Highly-Vascular Gastro-Intestinal Stromal Tumor

 

Large, Highly-Vascular Gastro-Intestinal Stromal Tumor

Large, Highly-Vascular Gastro-Intestinal Stromal Tumor

 

Large, Highly-Vascular Gastro-Intestinal Stromal Tumor

Large, Highly-Vascular Gastro-Intestinal Stromal Tumor

For a large, hyper-vascular tumor such as this GIST lesion, the combination of accurate vascular maps and high levels of soft tissue detail that can be provided by CR may prove very beneficial for pre-operative planning

 

Right Lower Pole Clear Cell Renal Cell Carcinoma

Right Lower Pole Clear Cell Renal Cell Carcinoma

 

Left Lower Pole Clear Cell Renal Cell Carcinoma

Left Lower Pole Clear Cell Renal Cell Carcinoma

The texture of the tumor and the extensive neovascularity are shown to good advantage by the CR images (red arrows in the bottom row of figures. Pre-operative planning in such complex cases may prove to be a valuable application for this 3D visualization technique

 

5 mm Clear Cell Renal Cell Carcinoma Detected Incidentally

5 mm Clear Cell Renal Cell Carcinoma Detected Incidentally

 

Infiltrating Right Kidney Renal Cell Carcinoma

Infiltrating Right Kidney Renal Cell Carcinoma

 

Left Kidney Transitional Cell Carcinoma

Left Kidney Transitional Cell Carcinoma

Careful scrutiny of the 2D and VR images demonstrates a lesion (red arrows) in the left renal collecting system.

 

Left Kidney Transitional Cell Carcinoma

Left Kidney Transitional Cell Carcinoma

 

Left Kidney Transitional Cell Carcinoma

Left Kidney Transitional Cell Carcinoma

 

Another Example of Left Kidney Transitional Cell Carcinoma

Another Example of Left Kidney Transitional Cell Carcinoma

 

Another Example of Left Kidney Transitional Cell Carcinoma

Another Example of Left Kidney Transitional Cell Carcinoma

Depending on the contrast phase and the widow width and settings used, a transitional cell carcinoma (red arrows) can appear as either a mass lesion or a defect within an excreted contrast column

 

Colorectal Metastasis to the Liver

Colorectal Metastasis to the Liver

 

Renal Cell Carcinoma Adrenal Metastases

Renal Cell Carcinoma Adrenal Metastases

Although the 2D and VR images demonstrate heterogeneity in these renal cell carcinoma metastases, the texture of that heterogeneity is much more apparent in the CR panels on the bottom

 

Metastatic Carcinoid Tumor

Metastatic Carcinoid Tumor

This example of metastatic carcinoid tumor (red arrows) to the mesentery has the typical calcifications and vascular tethering, with the effects on the vasculature well displayed on these CR images

 

Small Bowel Gastrointestinal Stromal Tumor

Small Bowel Gastrointestinal Stromal Tumor

 

Small Bowel Gastrointestinal Stromal Tumor

Small Bowel Gastrointestinal Stromal Tumor

 

Small Bowel Obstruction Secondary to Cecal Adenocarcinoma

Small Bowel Obstruction Secondary to Cecal Adenocarcinoma

 

Treated Gastrointestinal Stromal Tumor Liver Metastasis

Treated Gastrointestinal Stromal Tumor Liver Metastasis

 

Liver Hemangioma

Liver Hemangioma

 

Carcinoid Liver Metastases

Carcinoid Liver Metastases

 

Gallbladder Adenocarcinoma

Gallbladder Adenocarcinoma

 


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